Inside Health

HOSPITAL CLOSINGS; Details of Hospital Proposal Show Far Wider Cuts

Published: November 29, 2006

A long-awaited plan to shrink New York State's hospital industry landed yesterday with force, with proposals that could effectively eliminate 20 or more hospitals and thousands of jobs, and make dozens of other hospitals shrink, merge or take on new roles.

The recommendations by the Commission on Health Care Facilities in the 21st Century go far beyond the nine hospital closings and downsizings that state officials reported late Monday, after being briefed by the commission. Several other hospitals would cease to exist through mergers or conversion to new uses, and more could be eliminated if they refuse to merge.

In addition, the commission reached deep into the particular operations of many individual institutions, ordering them to eliminate specific numbers of beds, telling some to eliminate psychiatric, substance abuse or maternity wards, and in some cases directing others to take on those functions.

The changes would mark an epochal shift in an industry that, person for person, is much bigger in New York than in other states, and traditionally has fiercely resisted shrinkage. But hospitals are also in worse financial shape in New York than in any other state, having lost money for eight consecutive years.

Unless they are rejected by Gov. George E. Pataki or by the Legislature next month, the commission's recommendations will have the force of law, and most must be carried out by the end of next year. The law does not allow the governor or the Legislature to accept some recommendations and not others; they must accept or reject the plan as a whole. State officials said they would study the plan, and leaders in the Senate and the Assembly said they would hold hearings on the proposals before deciding what to do. [News analysis, Page B5.]

In all, the plan would reduce the number of hospital beds statewide by at least 4,200, or 7 percent. It would also close and downsize several nursing homes, mostly upstate, eliminating 3,000 beds, or 2.6 percent of the total.

The report's release rippled across New York State yesterday, as cities and towns grappled with the possible closings of some of their most dependable employers. From Long Island to Niagara Falls, hospital executives and elected officials denounced the commission's plan and vowed to fight it in the Legislature and in court.

''We will do everything possible to defend our ministry,'' said Joseph McDonald, chief executive of the Catholic Health System in Erie County. One of his hospitals, St. Joseph Hospital in Cheektowaga, near Buffalo, is among those marked for closing.

In Forest Hills, Queens, 150 people, including several politicians, gathered outside Parkway Hospital to protest its planned elimination, despite the hospital's dire financial problems. ''Closing this hospital is the equivalent of treating a head cold with an amputation,'' said Representative Anthony D. Weiner.

But the reaction from the major hospital and nursing home lobbying groups, and 1199 S.E.I.U. United Healthcare Workers East, the biggest hospital workers' union, was muted. ''They took a year and a half to put it together, so we want to take a few days to go through it and not be flip about it,'' said Dennis Rivera, president of the union.

The nine hospital closings, with five of them in New York City, have received the most attention, but other elements in the plan could have greater effects. Stephen Berger, the commission chairman, said at a news conference that far more significant were the commission's proposals to reshape dozens of other hospitals through mergers, downsizing, the elimination of some services and the addition of others.

''The reason this is a big deal is the 48 reconfigurations,'' he said.

Industry officials agreed with that assessment, and said they were taken aback by the number and detail of changes that some described as micromanaging.

In Buffalo and in Syracuse, government-owned hospitals would merge with privately owned ones, despite different unions and governing structures. In Port Jefferson, on Long Island, one hospital is ordered to drop all of its basic ''medical/surgical'' beds and devote itself only to treatment of mental illness and alcoholism, while its neighbor is instructed to do the reverse. In Auburn, in central New York, a hospital must eliminate its obstetric ward.

''The closures could be readily anticipated,'' said Kenneth E. Raske, president of the Greater New York Hospital Association. ''But the restructuring is so sweeping, I was just flabbergasted.''

The commission estimated that its plan would increase revenue at the surviving institutions by $720 million a year, as they take on patients from the places that have closed or changed missions. It also predicted that increased efficiency -- in particular, in the form of shorter hospital stays -- would save insurers, including Medicaid and Medicare, $800 million a year.

The commission said that where possible, hospitals should pay the costs of making the changes -- by selling unused real estate in some cases. But the state has offered $1 billion of its own money, and up to $1.5 billion in federal money, to aid the transition.